Around 40 percent of community-dwelling older adults in the United States have some form of disability that interferes with their capacity to function within their surroundings. Disabilities, by their very definition, make aging in place difficult to achieve, and are disproportionately more likely to affect lower-income individuals. For this reason, researchers affiliated with Johns Hopkins and other universities developed a six-month program known as Community Aging in Place: Advancing Better Living for Elders (CAPABLE). This program targets both environmental and individual factors to help low-income older adults with disabilities remain in their homes. A recent article in the Journal of the American Geriatrics Society describes a study to test the program’s effectiveness.
The researchers recruited 40 low-income older adults who reported difficulty with at least one activity of daily living (ADL). The participants, each of whom were age 65 or better and who scored 24 or better on the Mini-Mental State Examination, were recruited from a waiting list for home-based social services in Baltimore, Maryland. The researchers randomly assigned 16 participants to a control group, which consisted of up to ten 60 minute in-home sessions of relaxing activities (such as reminiscence or scrapbooking), conducted by a trained research assistant. The other 24 participants received the CAPABLE intervention, which involves individually-targeted nursing and occupational therapy, as well as minor home renovations and home repair. At baseline and after six months, both the control and the intervention group were assessed on difficulties with ADLs, falls risk, and health-related quality of life.
The CAPABLE intervention is an evidence- and theory-based program that targets environmental factors, such as housing safety and maintenance, and individual factors like self-care, mood management skills, strength training, and doctor-patient communication skills. Participants in the CAPABLE group received six home visits with an occupational therapist, up to four visits with a registered nurse (RN), and home repairs on an as-needed basis. The average expense on home renovations and repairs, which were focused around decreasing falls risk and optimizing personal mobility, was $1,285, ranging from $149 to $2,185. While not inexpensive, such an intervention has the potential to reduce long-term costs (such as nursing and medical care) by fostering healthy, safe aging in place and improving health-related quality of life.
Both the intervention and control groups were demographically similar, and had similar levels of ADL difficulty, falls risk, and quality of life. Participants in the CAPABLE intervention saw significant reductions in ADL difficulty and falls risk, and improved health-related quality of life. These findings suggest the usefulness of multi-component interventions that target both individual and environmental factors to help older adults age in place.
Szanton SL, Thorpe RJ, Boyd C, et al. (2011). Community Aging in Place, Advancing Better Living for Elders: A bio-behavioral-environmental intervention to improve function and health-related quality of life in disabled older adults. J Am Geriatr Soc 59: 2314-2320.